Mouth Taping--Consequences?

[birdshell]

Old thread, but I thought this was interesting. Just saw the doctor, who was somewhat comically shocked and appalled to actually meet someone who taped. He'd heard of it, and used the fact of it to illustrate people's desperation, but never had anyone admit to it before. After he said, "just don't," he went on to express his opinion that the mouth breathing is a symptom of improper titration. He changed me over to autopap. Worth thinking about.

I just had one of the sleep techs on Live Chat express the same opinion to me a few nights ago. He said that he simply does not put a full-face mask on anyone, regardless of their mouth opening. His opinion is that if the pressure is not correct, i.e. too high OR too low, then the mouth may be opened.

Now, mkirkwag posted the same opinion from a sleep doctor. Interesting, isn't it?

[rested gal]

I can't remember the last time I laughed so hard! Starving wolverine?!?

Yeah, I loved that piece!

Jhon 32, you give me wayyyy too much credit, but thanks.

Since your doctor has you using an autopap set 12 - 18 , I don't think you need to be looking for a different machine yet. If I were you I'd try a Full Face mask. Won't matter if you breathe through your mouth or leak air out your mouth when wearing a FF mask. But as for which mask... your guess is as good as mine.

I turned to tape because that let me wear nasal pillows masks. Otherwise I'd have had to keep wearing a FF mask.

But here's something interesting that just happened in the last couple of months... I had tried chin straps in the past. They did nothing to stop the mouth breathing I do in my sleep. So, I've been taping for over three years. Occasionally I'd try going without tape, but each time I looked at the leak rate on my data it showed crazy massive leaks.

I had resigned myself to the idea that I'd be buying tape for the rest of my life. No big deal. I was used to it and really didn't mind using tape.

Then a fellow "tape-er" -- blarg -- told me he'd been able to get a chin strap to work finally, and had been able to give up taping. I was doubtful it would work for me...hadn't in the past. But I gave it a try again, this time using (what else!! LOL ) a pantyhose leg.

Maybe it's from the years of taped lips causing the tongue to become accustomed to being in a "sealed" position, or maybe it's because I pulled the homemade strap wide enough at the under-chin area to give upward support directly under my lower lip, keeping the lower lip pushed upward....but for whatever the reason, this time the chin strap has been getting the job done.

I've been able to use the homemade chin strap and no tape for two months now, and have been getting a very low, very steady leak rate on my overnight data. A leak rate every bit as consistently low as back when I used tape.

So, there are all kinds of ways to go about controlling mouth air leaks. Even some old ways that perhaps didn't work well at first are worth re-visiting from time to time.

I don't think the type of machine makes much difference when it comes to controlling mouth air leaks. The placement of the tongue is the whole key to creating an airtight seal inside the mouth.

While you work out whatever method gets that done for you, it's always a good idea to have a FF mask in the stash. If for nothing more than to have something that will allow you to mouth breathe and still get treatment on a night when congestion (a cold or bad allergies) make you nose too stuffy to get air through at all.

The only reason I'm using the BiPAP Auto is for comfortable exhaling. Now that the Auto with A-Flex is out, that machine sounds like it's just as comfortable. But I don't think either would have much effect on whether a person is going to leak air out the mouth.

I've been a big-time mouth air leaker on any kind of machine I've ever used, including the BiPAP Auto. Until now. And it still does take the homemade chin strap to keep not only my jaw, but also my lower lip up enough to let my tongue stay in a sealing position inside my mouth. Keeping the lower lip up apparently prevents little air puffs from escaping -- which used to turn into gushes of air out the mouth.

Good luck, John.

[ozij]

You'll find that opinion in one of the classic books about apnea, written by a well know sleep doctor. The book is "Restless Nights" the author Peretz Lavie, and according to him, mouth breathing when you sleep is a reaction to an apnea and therefore, with proper titration it won't happen.

On the other hand, this study compared people who mouth breathed during the diagnostic study with those who did not - All (mouth breathers and nose breathers) had an RDI higher than 15.
(MB=mouth breather, NB=nose breather)

Mouth Breathing Compromises Adherence to Nasal Continuous Positive Airway Pressure Therapy

Continuous positive airway pressure (CPAP) is an effective treatment for sleep-disordered breathing (SDB).1 Adherence to CPAP therapy in the community has shown rates ranging from 65 to 88%.23 Despite numerous improvements in the technology of CPAP devices, however, the major challenge to physicians is to increase acceptance of and adherence to this treatment.4

Most studies have tried to predict adherence to CPAP based on the response during the early period of use,567 or on the severity of the disease.8 Meanwhile, identifying a risk group before starting CPAP would be economical and may justify the early use of autotitrating CPAP,9 chin strap, full face mask,10 oral mask,11 and heated humidification,12 in addition to basic educational and behavioral support.13

Mouth opening increases upper-airway collapsibility during sleep and may contribute to the occurrence of SDB.14 Mouth leak with CPAP does occur in 10 to 15% of cases,15 and may compromise CPAP therapy.4 To predict this leak, we hypothesized that patients who breathe mainly through their mouths during sleep would have more mouth leak during CPAP and therefore lower adherence to CPAP. We therefore quantified mouth breathing during sleep in patients with moderate-to-severe SDB and followed their subsequent adherence to CPAP therapy.

Baseline Demographics and Sleep Characteristics
We studied 51 patients (4 women). MBs and NBs did not differ with respect to age, sex, body mass index (BMI), neck circumference (NC), ESS, AUDIT score, TST, TST while supine, rapid eye movement (REM) sleep, wakefulness after sleep onset (WASO), sleep efficiency, RDI while supine, or pulse oxygen saturation (SpO2) awake. Meanwhile, total arousal, respiratory arousal, RDI, and an oxygen desaturation index of 4% (ODI4) were higher in MBs, but the amount of delta sleep was lower

Effect of Nasal CPAP on Mouth Breathing
In MBs receiving CPAP, mouth breathing decreased significantly (p < 0.001), from 84.5 ± 8.9% at baseline to 30.0 ± 18.9% and to 21.4 ± 17.5% of TST on the second titration night and at 3 months, respectively. In addition, in NBs, mouth breathing decreased significantly (p < 0.05), from 19.9 ± 7.8% at baseline, to 7.7 ± 7.7% and to 11.1 ± 13.5% of TST on the second titration night and at 3 months, respectively. Mouth breathing remained, however, significantly higher (p < 0.05) in MBs than in NBs at the two follow-up time points (Fig 4 ).

When scoring mouth breathing, we did not distinguish mouth opening at the end of apnea caused by choking and oral breathing. As choking is more frequent in severe SDB, it is possible to explain the higher RDI in our MBs. Nevertheless, we could not consider mouth breathing as a marker of SDB severity, because no significant correlation appeared between RDI and mouth breathing. In a recent review, Rappai et al25 postulated that the switch to oronasal breathing that occurs with chronic nasal conditions is a final common pathway for SDB.

Rappai et al The Nose and Sleep-Disordered Breathing
O.

[rested gal]

Just saw the doctor, who was somewhat comically shocked and appalled to actually meet someone who taped. He'd heard of it, and used the fact of it to illustrate people's desperation, but never had anyone admit to it before. After he said, "just don't," he went on to express his opinion that the mouth breathing is a symptom of improper titration. He changed me over to autopap. Worth thinking about.

I just had one of the sleep techs on Live Chat express the same opinion to me a few nights ago. He said that he simply does not put a full-face mask on anyone, regardless of their mouth opening. His opinion is that if the pressure is not correct, i.e. too high OR too low, then the mouth may be opened.

Now, mkirkwag posted the same opinion from a sleep doctor. Interesting, isn't it?

Interesting, and might apply to some, but I think it's more complicated than that for a lot of people. For many of us, it's not just a matter of whether the mouth is open or closed. The geometry of the inside of the mouth and the size and placement of the relaxed tongue have a lot more to do with whether air can leak out of the mouth in puffs or gushes, imho. If the tongue doesn't form a seal inside the mouth, it doesn't matter whether the titrated pressure is "right" or not...imho. If the tongue is in a sealing position, the mouth can be relaxed slightly open and no air will leak out.

I think that's why chin straps can be all it takes for some people -- just keeping the jaw closed to take up space inside the mouth and allow the tongue to fill it.

That wasn't enough for me, though. Even with jaw closed, air could still sneak around the back molars and puff on out from between loosely closed lips.

The homemade chin strap I use now, with part of it pulled up under my lower lip to help keep the lips closed in order to prevent lip air puffs from getting started, is doing the trick. If it didn't, I'd definitely keep on taping my lips shut, as I did for over three years.

If the geometry of the inside of the mouth is such that just having enough pressurized air going down the airway at the back of the throat will keep a person's tongue in a sealing position, that's great. In those cases, what the sleep tech said he/she observed would happen.

However, I think there are a LOT of exceptions to that. And those exceptions do have to turn to other methods of stopping mouth breathing and/or mouth air leaks. Methods like chin strap or tape or an appliance inside the mouth to force the tongue into a sealing position. Or... a FF mask. I really don't think it's always as simple as just arriving at the "right pressure."

[rested gal]

Interesting links, ozij. Thanks for posting those.

I went to the first linked study (Mouth Breathing Compromises
Adherence... ) to find out their conclusion:

--------------------------

Discussion

The main finding of this study is that in patients
with SDB, a high percentage of mouth breathing
during sleep represents a risk for low adherence to
CPAP. Furthermore, although mouth breathing decreases
considerably when patients are put on nasal
CPAP, MBs still have considerably more mouth
breathing on CPAP than do NBs. We also found a
significant correlation in all patients between use of
CPAP at 1 month and its long-term use. These
findings are consistent with others, that mouth leak
may compromise CPAP therapy,4,20 and that the first
period of CPAP use predicts long-term adherence.21
Several limitations of this study may limit the
generalizability of our results. We are a university
sleep center receiving patients with SDB referred
from local health-care centers. In addition, no patients
with mild SDB were included, as the benefits
of CPAP treatment for such patients are less clear.22
Our patients did not receive heated humidity or a
full face mask,12 and 94% of them were male
subjects. Our findings may not apply to women or
apply to the use of humidity. Moreover, we did not
use a chin strap to reduce mouth leak with CPAP, as
our recent study23 showed the inefficacy of this
method. In addition, thermistors used for monitoring
nasal and oral airflow at baseline provide measurements
more qualitative than quantitative.24 Finally
we agree that the low ESS scores of our patients may
have reduced their adherence to CPAP, as has been
suggested.2 (bold emphasis mine)

hmmm. So, without even trying a chin strap, or using heated humidification, or even trying a Full Face mask at some point after the titration, the researchers concluded mouth breathers would have lower adherence to using cpap than nose breathers.

Given the discomfort of some FF masks, yeah...even if they had tried a FF mask there might have still been lower adherence to using cpap in the mouth breathers, but gosh...give 'em a chance! LOL!!!

I mean, at least one chance prior to the final followup, before saying this:

Our finding is clinically important, and may be of considerable economic benefit, because it may predict the likely success of CPAP before its initiation. (bold emphasis mine)

Which sounds a lot like saying, "Hey, to avoid wasting money on mouth breathers, don't bother giving them a cpap machine."


Yes, I do understand that the purpose of this study was not to see if mouthbreathers could become more adherent to cpap therapy if a few things were tried (like a FF mask.) Conclusions like that just bother me. Oh well.

[MLefholtz]

I'd like to add my comments to the mix. In no particular order.

1. I told the sleep doc on my last visit, that I tape. He didn't bat an eyelash. This may or may not be relevant, since I've never seen the same sleep doc twice. There are six in the practice and I've only had four appointments.

2. I did not have mouth leaks during my titration study, but began to mouth leak almost immediately upon using my own machine in my own home under more familiar conditions. I was quite satisfied with my choice of the Comfortlite 2 mask and so began taping on my fourth or fifth night.

3. I've been a daytime mouth breather much of my life. I'm sure it was originally based on the fact I couldn't breathe through my nose, but I had septoplasty surgery, with turbinate reduction and polyp removal about 20-25 years ago. This surgery was successful, but to this day I still mouth breathe during the day time. It's sort of weird, but I hum. I hum tunes on my breath. Nothing to do with my vocal chords, but it's comforting to me and I can't really imagine not doing it. Nevertheless, prior to OSA diagnosis, I would sleep with my mouth open, most of the time. RG questioned whether years of taping had reconditioned her tongue positioning ("Maybe it's from the years of taped lips causing the tongue to become accustomed to being in a "sealed" position...") At any rate, I think I'm experiencing something similar. I've be unable to use my cpap much lately due to pain in my hips and legs (finding a comfortable position to sleep in). When I nap or sleep at night, without cpap, my mouth remains closed. This is most amazing to me, and to my wife.

4. To make what I've stated above a little more sensical, I am one of those whose sleep apnea appeared relatively suddenly after a weight gain of approx. 25 lbs. in the course of various medical treatments. I've now lost about 27 lbs. My wife reports that I no longer stop breathing or gasp for air. I don't really know what this means. However I too am considering purchase of a recording oximeter to see what my oxygen stats look like now. I feel I can justify the purchase partially by the fact that I would truly love to convince a son-in-law that he has sleep apnea. He is diabetic, he snores loudly and his wife reports that she knows he stops breathing and that she pokes him to get him going again.

That's about all for now. I surely appreciate the amount of sharing on this board. I feel privileged to be a part of it. Thanks all.

Mike

[socknitster]

Rested Gal wrote:

If the tongue doesn't form a seal inside the mouth, it doesn't matter whether the titrated pressure is "right" or not...imho. If the tongue is in a sealing position, the mouth can be relaxed slightly open and no air will leak out.

This is so true! I caught myself doing this while exercising recently!

I was unconsciously moving my tongue to that spot just behind top front teeth when I inhaled thru my nose and dropping my tongue ever so slightly to exhale thru my mouth. This wasn't contrived at all. My body naturally was doing it as I jogged along on an eliptical trainer and working hard. I just noticed it. My mouth was slightly open the whole time, but air only went through my mouth when my tongue dropped on exhale. On inhale it was completely sealed. Needless to say it made me think about how this could apply to xpap.

I'm beginning to wonder about the pillow I'm using. it is a memory foam pillow that is rounded at top and bottom with a concave portion in the middle. I'm wondering if it isn't causing my throat to go into the "CPR" position and naturally drop open during sleep. I'm going to get some pantyhose today and try a very flat old pillow tonight to see if that position will work better for me!

Thanks for the tip RG. Can you describe how you cut the pantyhose and how you use them in more detail? I am trying unsuccessfully to picture it.

jen

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): seal

[rested gal]

Jen, it's the usual leg cut off a pair of pantyhose tights. Same as what I use for a strap to steady masks better. Not just pantyhose...pantyhose "tights"...as the material in tights is a tad thicker and can keep its width better. Very soft and stretchy.

I don't cut them in any special way. It's just a cut-off leg.

The leg used as a chin strap goes under the chin and up to the top of the head, like any commercial chin strap. At first I was tying it on top of my head with my usual doublestart knot. But to work as a chin strap, I had to tie it tighter up there than how I tie the "leg" when used to steady a mask. My hair was getting caught in the knot as I tightened it so much.

So, after I found that it did work for me, I cut the leg to fit snugly and sewed the ends together. I guess a person could sew velcro up there, but I'm not a velcro fan.

The part you're probably trying to visualize is what I said about getting the leg to add support under the lower lip. That's where using "tights" material is more useful than just plain pantyhose because regular pantyhose tends to roll itself into a thin strip when pulled tight.

After I have put it on as a chin strap, I take my fingers and work a front edge of the tights out and up over the front of my chin. That pushes the skin of the chin up a bit, to help keep the lower lip from dropping during the complete relaxation of sleep. The front of the strap is sometimes almost touching my lower lip when I pull it up that way.

I tried that before, several years ago...tried using a pantyhose tights leg as a chin strap (as well as trying a couple of commercial chin straps.) None of it worked back then. But, as I mentioned, the 3 years of using tape to keep my lips closed seems to have caused my tongue to get used to staying in a sealing position inside my mouth while I sleep. So, the homemade chin strap finally does get the job done for me now.

Good luck!

[ozij]

Our finding is clinically important, and may be of considerable economic benefit, because it may predict the likely success of CPAP before its initiation. (bold emphasis mine)

Which sounds a lot like saying, "Hey, to avoid wasting money on mouth breathers, don't bother giving them a cpap machine."

Another valid interpretation could be: Don't expect moutbreather's to adapt to cpap machines without investing in extra support for them.

The authors do say:

Our study showed that adherence to CPAP was significantly lower in MBs than in NBs. We postulate that MBs have more difficulties in accepting a new breathing pattern, one exclusively nasal, than do NBs, resulting in more mouth leak with CPAP. Furthermore, our four patients who refused CPAP after titration were all MBs. In this study, because sleep and respiratory parameters were significantly better on CPAP for all patients, the lower adherence of MBs cannot be attributed to CPAP inefficiency, nor to the difference in patient age or gender, as has been suggested.2

Looked at from a money aspect, proper treatment of sleep apnea saves money for insurance companies and society as a rule because it prevents - or even cures - some of the co-morbidities.

O.

[ZZZCPAPZZZ]

I don't see the point of this study since there is such a thing as a full face mask. The study only seems to be about nasal masks or am I being stupid?

[ozij]

Let's put it this way:

This study points out that if people are diagnosed with sleep apnea, and are mouthbreather in the diagnostic study special care should be taken with their further treatment.

Even if their mouthbreathing is reduced during the titration study (which this study shows is something that does happen) the mouthbreathers might run into more trouble along the way when adapting to cpap.

Another point of the study is the following:

We recommend the detection of mouth breathing during sleep, not only for predicting adherence to CPAP therapy, but also for avoiding the use of CPAP titration devices that use nasal mask pressure-vibration detection as their only mode of pressure setting; such devices fail to recognize all the respiratory events in patients with significant mouth breathing

Meaning: care should be taken with how these patients are titrated to start with.
O.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, CPAP

[socknitster]

Jen, it's the usual leg cut off a pair of pantyhose tights. Same as what I use for a strap to steady masks better. Not just pantyhose...pantyhose "tights"...as the material in tights is a tad thicker and can keep its width better. Very soft and stretchy.

I don't cut them in any special way. It's just a cut-off leg.

The leg used as a chin strap goes under the chin and up to the top of the head, like any commercial chin strap. At first I was tying it on top of my head with my usual doublestart knot. But to work as a chin strap, I had to tie it tighter up there than how I tie the "leg" when used to steady a mask. My hair was getting caught in the knot as I tightened it so much.

So, after I found that it did work for me, I cut the leg to fit snugly and sewed the ends together. I guess a person could sew velcro up there, but I'm not a velcro fan.

The part you're probably trying to visualize is what I said about getting the leg to add support under the lower lip. That's where using "tights" material is more useful than just plain pantyhose because regular pantyhose tends to roll itself into a thin strip when pulled tight.

After I have put it on as a chin strap, I take my fingers and work a front edge of the tights out and up over the front of my chin. That pushes the skin of the chin up a bit, to help keep the lower lip from dropping during the complete relaxation of sleep. The front of the strap is sometimes almost touching my lower lip when I pull it up that way.

I tried that before, several years ago...tried using a pantyhose tights leg as a chin strap (as well as trying a couple of commercial chin straps.) None of it worked back then. But, as I mentioned, the 3 years of using tape to keep my lips closed seems to have caused my tongue to get used to staying in a sealing position inside my mouth while I sleep. So, the homemade chin strap finally does get the job done for me now.

Good luck!

RG, I'm so glad you clarified how you are using the hose because I definitley had the WRONG idea! I was planning a trip to the store today anyway--will be looking at tights too (in a whole new way!)!

Jen

[meister]

Rested Gal,
From looking at your Oximeter results I can tell that you are both
a smoker, and that you don't get out and run a whole lot. Your baseline
O2 levels would be higher without the cigarettes.

I have an oximeter and made everyone in my extended family sleep with it so I could compare data. It was very amazing comparing my 20-year-old son who runs everyday, with my 90-year-old father who smokes 3 packs
each day.

As for the mouth tapers who have died, all I can say is they sure
don't seem to post much after that big event!

I tape every night. It was RG who convinced me to get started with it.
When I did my sleep study a couple of the lab techs told me that they
had Sleep Apnea and that they taped, but that they were FORBIDDEN
from discussing it with any patients.

I use 2 inch Blenderm tape

http://www.qualitymedicalsupplies.com/p ... CTGY/73-BD

I have never heard of anyone throwing up in their sleep. Usually folks
are halfway to the bathroom when they heave.

My family Doctor screamed "Are you nuts?" when I told her that I taped.

Chinstraps never worked for me. I actually documented that my
stats got much worse when wearing a chinstrap, because it pushed my
jaw back and reduced my airway diameter.

Oximeters are great to show that one can get just as great Apnea control
by wearing a nice Dental Device, as when wearing a CPAP mask. I use
a titratable TAP-II and can show differences in my AHI with different
settings.

Taping helps hold my chin up and keeps my lips closed. I have a
full bushy mustache and beard.

[Offerocker]

I have never heard of anyone throwing up in their sleep. Usually folks are halfway to the bathroom when they heave.

Meister:
Well, you've "heard it now", !
"Been there, Done that, Got the towel"

There have been very few times that the medication for Acid Reflux didn't work sufficiently...or I ran out of meds,
and it was a harrowing experience!
You think waking up during an Apnea is scary...

My 'blankie' is now a towel ...just in case

[lilsheba]

I was a mouth breather but have started mouth taping since reading about it on here. And between that and the cpap I have been forced to nose breathe and I think I'm adapting quiet well. I wake up every once in a while with my cheeks puffed out with air that's trying to get out and can't but it's rare.